Ever since the Affordable Care Act’s insurance marketplaces opened for business in 2014, the Obama administration has worked hard to get Americans to sign up. Yet officials now are telling some older people that they might have too much insurance and should cancel their marketplace policies.

Each month, the Centers for Medicare and Medicaid Services is sending emails to about 15,000 people with subsidized marketplace coverage. The message arrives a few weeks before their 65th birthday, which is when most become eligible for Medicare.

President Obama admitted in a far-ranging interview about his presidency that his signature health law has “got real problems.” He said he encouraged Democrats to “walk the plank to get the Affordable Care Act done,” despite their (well-founded) fears they could lose their seats over their votes. “Now, part of my argument to them was, you’ve already paid the price politically, it’s not as if a failed health-care effort would be helpful in midterm elections, it’s better to go ahead and push through and then show that we had gotten something done that was really important to the American people.” (He admits that the party was absolutely ready to take massive casualties to get the last leg of its political agenda passed.)

Take Wellcare Health Plans’ announcement that it has signed a deal to buy the Arizona operations of Care1st Health for $157.5 million in a deal that will add 114,000 Medicare and Medicaid beneficiaries in the state’s largest market, Maricopa and Pima counties.

Tennessee is ground zero for ObamaCare’s nationwide implosion. Late last month the state insurance commissioner, Julie Mix McPeak, approved premium increases of up to 62% in a bid to save the exchange set up under the Affordable Care Act. “I would characterize the exchange market in Tennessee as very near collapse,” she said.

Then last week BlueCross BlueShield of Tennessee announced it would leave three of the state’s largest exchange markets—Nashville, Memphis and Knoxville.

Proponents of the Affordable Care Act made several promises before and since the law passed. The most notorious of these was President Barack Obama’s assurance that people could keep their insurance plan if they liked it. However, other important promises were made that have garnered less media coverage, including how many people would enroll for coverage in the new health insurance exchanges, the law’s effect on health insurance premiums, the amount of choice and competition in health insurance markets, and the law’s impact on overall costs and the deficit. These promises arguably helped ensure some of the votes necessary for the controversial legislation to pass Congress.

The cost of expanding Medicaid under President Barack Obama’s health care overhaul is rising faster than expected in many states, causing budget anxieties and political misgivings.

Far more people than projected are signing up under the new, more relaxed eligibility requirements, and their health care costs are running higher than anticipated, in part because the new enrollees are apparently sicker than expected. Rising drug prices may also be a factor.

For weeks, rumors have been flying that WikiLeaks would deliver an “October surprise” for Hillary Clinton’s campaign, a bombshell revelation that she would struggle to recover from in the short weeks remaining until the election. (So far, it’s a dud — surprise!)

But Clinton should be worried about a “November surprise” — the wave of policy cancellations and rate hikes that will attend the debut of Obamacare’s fourth open-enrollment period, on Nov. 1. Just a week before Election Day.

Many variables remain up in the air as we contemplate what Obamacare would look like without functioning exchanges, but the failure of the exchanges in some states might provide an opportunity to amend and improve upon the ACA, and move the American health care system towards a freer market system where individuals are free to enroll in any health insurance plan that is for sale, and where insurers have the freedom to sell the plans that are the most appealing to potential buyers. Treating markets where the ACA has failed as opportunities rather than crises might be the first step in achieving sustainable health care reform.

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The Affordable Care Act hasn’t done much to change trends of low-income people seeing changes in their health insurance coverage, a new study finds.

About a quarter of low-income adults in three states have experienced a change in their health insurance coverage, known as “churning” under the Affordable Care Act, according to a study released today by the Harvard T.H. Chan School of Public Health in the journal Health Affairs. Maintaining insurance coverage over time can remain difficult under the law, the researchers found.